3. Policy Context
The provision of support to older adults has been subject to myriad policy developments in recent years. It is widely acknowledged that the majority of people wish to remain at home throughout their life (eg Eckert et al, 2004). Evidence suggests that this can result in positive mental well-being (Cutchin et al, 2009) and can delay the onset of illness and dependency (Elkan et al, 2001).
It has also been assumed that supporting people to remain at home will reduce the cost of care for older people (Dickinson et al, 2010). Given the predicted increase in the older population in Scotland this is an important consideration. In order to produce efficiency savings the Government has suggested that innovative approaches to providing support at home that make use of technology will become increasingly important.
The review of policy developments across the UK revealed a number of trends. The first related to the promotion of choice via the personalisation agenda. Research suggests that older people with higher level needs and people with dementia need additional support to take advantage of self-directed support (Glendinning et al, 2008; Alzheimer’s Scotland, 2010). A study by the Audit Commission in England (2010) found that personal budgets did not necessarily save money for local authorities but that they did produce better outcomes for service users and carers.
The second key area relates to the promotion of independence for older people, part of the Shifting the Balance of Care agenda (Scottish Government, 2008). This identified a number of areas for improvement around maximising care at home, reducing inappropriate admissions and improving joint working. A key message was around the development of anticipatory care in order to meet the needs of older people before they reach crisis point. Likewise, the National Dementia Strategy (2010) highlighted the need for early diagnosis. It also emphasised the need to provide appropriate support to people with dementia and their carers at home.
A focus on outcomes is also inherent within the policy agenda, with outcomes-focused assessment and provision being recognised as increasingly important. The evidence base suggests that service users in receipt of such services have reported improvements in confidence and physical functioning (Glendinning et al, 2007; Manthorpe et al, 2007).